| NPI | 1124459953 |
|---|---|
| Former Name | STEPHANIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252248) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33006824A) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2020-01-31 |